MOBILE HOME PARK APPLICATION

Transcription

1 MOBILE HOME PARK APPLICATION PART 1 - GENERAL INFORMATION A. WILL THIS BE YOUR PRIMARY RESIDENCE? Yes No 22 Keith Ave., Ste. 100 Barre, VT B. LOT INFORMATION Name of Park Lot Number Name of Current Mobile Home Owner C. ACTION REQUESTED PURCHASING Existing home on lot New home to be placed on vacant lot Used home to be placed on vacant lot I am paying cash for the home OR I am financing the home JOINING AN EXISTING HOUSEHOLD Financial Lender Contact Name Contact Telephone Loan Amount Community Household Lot Number D. PETS We do not allow outdoor cats or pet dogs in our properties. Animal Breed Current Shots NAME MAILING ADDRESS PHYSICAL ADDRESS TELEPHONE PART 2 - APPLICATION INFORMATION First Last Middle Initial Maiden Name PO Box / Street City / Town State / Zip Code Street Address City / Town State / Zip Code Home Cell Work

2 PART 3 - FAMILY COMPOSITION - List all persons who will be living in the household. Names of Household Members Relationship to Head of Household Social Security Number Date of Birth HEAD PART 4 - INCOME EMPLOYMENT INFORMATION: List all full and/or part-time employment for all members of the household. Family Member Employer Name & Address Employer Phone # Rate/Hour Hours/Week Downstreet Office Use Only OTHER INCOME: List income from: Welfare, Reach Up, General Assistance, Social Security, SSI, Pensions, Workers Compensation, Unemployment Compensation, Child Support or Alimony, and/or other. Family Member Income Source ID/Claim # Amount Check One Downstreet Office Use Only Week Month Year Week Month Year Week Month Year

3 ASSETS (Bank Accouts, IRAs, Pensions, Stocks, Bonds, Insurance Policies, and/or other): Please list all accounts held by each person who ll live in your unit. Attach a separate sheet of paper if needed. Household Members Bank/Institution Account Number Interest Rate Current Balance OTHER ASSETS Do applicants own real estate other than the home in which you live? Yes If yes, what is the location? No Market Value PO Box / Street City / Town State / Zip Code Is this an income-producing property? Yes No Does anyone applying own any other asset not already listed? (Do not include furniture. Do not include motor vehicles used for personal transportation.) Yes No If yes, please describe: Have you or ay member of the household disposed of, transferred or otherwise given away any cash property or other assets for less than they are worth in the past two (2) years? Yes No If yes, please describe: Cash Value Amount Received Date disposed of: / / Do you or any member of the household receive regular gifts or contributions from any person or organization? (Gifts or contributions include: cash, non-cash items, bills paid on your behalf, or items paid on your behalf.) Yes No If yes, please describe: Cash Value Received from: How often (i.e. monthly)?

4 PART 5 - HOUSING REFERENCES Fill out this information for all places you ve lived in the past five (5) years, not including your present housing. Attach a separate sheet of paper if needed. Landlord Name Property Address Landlord Telephone # Dates You Lived Here PERSONAL REFERENCES: Plesae list three (3) non-relative personal references. NAME COMPLETE ADDRESS TELEPHONE # AND/OR PART 6 - CONSENT FOR RELEASE OF INFORMATION/CERTIFICATION OF COMPLETION My signature below authorizes Downstreet to obtain any information that is pertinant to eligibility and suitability for residency at the mobile home park to which I have applied and certifies that the information listed on this application is complete and true to the best of my knowledge. Photocopies of this authorization may be used. This original is retained by the requesting organization. Applicant Signature Date Co-Applicant Signature Date Other Adult Signature Date Other Adult Signature Date

5 Applicant: Last First Middle Maiden or Alias Name(s): Date of Birth: / / Social Security Number: - - Gender: Race: Phone #: List all states in which you have lived: RELEASE I hereby authorize Downstreet to conduct a comprehensive background check that includes any one or all of the following: past employment and tenancy, criminal, drug, and driving records. I understand that the results of checks will be made available to Downstreet for use in reviewing my initial and continued suitability as a tenant. I am aware that the background reports I consent to have prepared may include information obtained from a variety of sources, including but not limited to government agencies, national credit reporting agencies, and other sources. I am aware that if I choose, I may obtain a complete disclosure of the nature and scope of any report prepared about me if I make a written request to the relevant reporting agency within 72 hours of learning the results: Screening One, Inc., 2233 W. 190th St., Torrance, CA (866) or Vermont Criminal Information Center, Department of Public Safety, 103 South Main St., Waterbury, VT I understand that a photocopy, facsimile, or scanned copy of this signed document shall be considered as valid as an original. _ Signature of Applicant Date

6 AUTHORIZATION TO RELEASE INFORMATION Please Print Name(s) of person(s) requesting services: 22 Keith Ave., Ste. 100 Barre, VT Name Social Security # D.O.B. Name Social Security # D.O.B. Address: Phone: Address: Phone: This document constitutes my/our consent for the following organization(s) to release information to Downstreet Housing & Community Developoment to release information to said organizations(s), for the purposes of any/all housing related services. i.e. any/all rental programs, Down Payment and Home Purchase Services, Homebuyer Education/Counseling, Credit, Budget, and Financial Counseling, Foreclosure/Mortgage Delinquency Counseling, Home Rehabilitation and Lending Services: Credit Bureau Services of Vermont (CBC) and Equifax, Experian, and TransUnion to obtain my credit report Banks and/or other lending institutions associated with the transaction(s), to include providing a copy of my HUD-1 Settlement Statement to Downstreet upon the purchase of my home. Attorneys, mediators, and/or title companies associated with the transaction(s) Creditors and/or collections agencies Efficiency Vermont Habitat for Humanity USDA Rural Development (RD) Vermont State Housing Authority Vermont Housing Finance Agency Homeowner s Insurance/Hazard insurance agencies and/or companies Any and all Social Service Agencies to which I am referred Social Security Administration My employer(s) for purposes of verifying employment and income Depositories for purposes of verifying account balances and account history Housing Advisors: Kira Charissakis and/or Cheryl Moyer, Downstreet Other: A photographic or carbon copy of this authorization bearing a photographic or carbon copy of the signature (s) of the undersigned may be deemed to be equivalent to the original hereof and may be used as a duplicate original. Signature: Date: Signature: Date:

7 INTENT TO SELL MOBILE HOME 22 Keith Ave., Ste. 100 Barre, VT Name of Mobile Home Park: Lot # Name: Date of this Notice: _ Address: Telephone Number: _ Date home will be posted or listed for sale: Name, address and telephone number of agent involved, if any: Asking price of home: Year Make Model Size Bedrooms Appliances Etc. Reason for selling home: Does Downstreet have permission to give your name, address and telephone number to prospective buyers? Yes No I have read my mobile home park lease regarding the intended sale of my home. I understand and will abide by the requirements for selling my mobile home as stated in my Mobile Home Park Lease Agreement. Signature of Owner: Date: Signature of Owner: Date: